The document emphasizes the significance of medical ethics, outlining key principles like autonomy, beneficence, and confidentiality, which guide physician-patient relationships and medical practices. It discusses the ethical responsibilities of physicians towards patients, public health, and fellow healthcare professionals, stressing the importance of informed consent, maintaining medical records, and ensuring equitable treatment. Additionally, it addresses unethical practices, provides a framework for research ethics, and includes case studies that highlight complexities in applying ethical principles.

3. Importance of Medical Ethics
 Ethical principles such as respect for persons,
informed consent and confidentiality are basic
to the physician-patient relationship.
 Application of these principles in specific
situations is often problematic , since
physicians, patients, their family members and
other healthcare personnel may disagree
about what is the right way to act in a
situation.

4.  The study of ethics prepares medical
professionals to recognize difficult situations
and to deal with them in a rational and
principled manner.
 Ethics is also important in physicians’
interactions with society and their colleagues
and for the conduct of medical research.

5. Principles of Medical
Ethics
Autonomy
Beneficence
Confidentiality
Do no harm/ Non-maleficence
Equity or Justice

6. Autonomy
 This includes the need to tell the
truth (veracity) and to be faithful to
one’s commitments (fidelity).

7.  Patient has freedom of thought,
intention and action when making
decisions regarding health care
procedures.
 For a patient to make a fully informed
decision, she/he must understand all
risks and benefits of the procedure and
the likelihood of success.

8. Beneficence
 The practitioner should act in “the
best interest” of the patient - the
procedure be provided with the intent
of doing good to the patient.
 Patient’s welfare is the first
consideration.

9. Confidentiality
 Based on loyalty and trust.
 Maintain the confidentiality of all
personal, medical and treatment
information.
 Information to be revealed for the benefit
of the patient and when ethically and
legally required.

10. Do no harm/ Non-maleficence
 “Above all, do no harm”

Make sure that the procedure does
not harm the patient or others in
society.

11.  When interventions undertaken by
physicians create a positive outcome
while also potentially doing harm it is
known as the "double effect."
Eg,. the use of morphine in the dying
patient. eases pain and suffering while
hastening the demise through suppression of
the respiratory drive.

12. Equity or Justice
 Fair and equal distribution of scarce
health resources, and the decision of who
gets what treatment.
 The burdens and benefits of new or
experimental treatments must be
distributed equally among all groups in
society.

13. Ethical Codes
 Hippocratic Oath – 5th century BC
 Nuremberg Code -1948
 Declaration of Geneva - 1948
 Universal Declaration of Human Rights-1948
 Helsinki Declaration -1964
 International Code of Medical ethics
 Indian Medical Council (Professional
Conduct, Etiquettes and Ethics) Regulations,
2002

15. Duties and responsibilities of physician in
general
 Character of Physician
 Uphold dignity and honour of his profession.
 Render service to humanity.
 Person with recognized qualification can only
practice modern system of medicine.
 Maintaining good medical practice.
 Render service to humanity with full respect for the
dignity of profession and man.

16. Duties and responsibilities of physician in
general
 Maintenance of Medical records
 Maintain the medical records pertaining to his / her
indoor patients for a period of 3 years.
 Records to be given within 72 hrs (if requested by
patients/legal authorities).
 Maintain a Register of Medical Certificates giving
full details of certificates issued.
 Display of registration numbers.
 Use of Generic names of drugs.

17. Duties and responsibilities of physician in
general
 Highest Quality Assurance in patient care
 Exposure of Unethical Conduct
 Payment of Professional Services
 Personal financial interests of a physician should
not conflict with the medical interests of patients.
 Evasion of Legal Restrictions
 Physician shall observe the laws of the country in
regulating the practice of medicine.

18. Duties of Physician to their patients
 Obligations to the sick
 Always respond to the calls of the sick.
 Ailment not within range of experience he can
refuse treatment and refer.
 Patience, delicacy & secrecy
 Patience and delicacy should characterize the
physician.
 Secrecy of patients to be maintained except when
required by laws of the state and to protect
healthy individuals.

19. Duties of Physician to their patients
 Prognosis
 Neither exaggerate or minimize gravity of patient’s
condition
 Do not neglect the patient
 Physician free to choose.
 Once undertaken should not neglect the case.
 Respond to request in emergency.

20. Duties of Physician in consultation
 Avoid un-necessary consultation
 Consulting p
a
t
h
o
l
o
g
i
s
t
, radiologist or asking
for lab investigation should be done judiciously .
 Consultation for patient benefit.
 Punctuality in consultation.
 Statement to patient after consultation.
 Treatment after consultation.
 Patient referred to specialist.
 Fees and other charges.

21. Responsibilities to Each Other
 Dependence of Physicians on each other
 Should consider it as a pleasure and privilege to render
gratuitous service to all physicians and their
immediate family dependants.
 Conduct in consultation
 Respect should be observed towards the physician in-
charge of the case and no statement or remark be
made.

22. Responsibilities to each other
 Consultant not to take the charge of the case.
 Appointment of the substitute
 only when he has the capacity to discharge the
additional responsibility along with his / her other
duties
 Visiting another Physician's case-
 Avoid remarks upon the diagnosis or the
treatment that
has been adopted.

23. Duties Of Physician To Public And
Paramedical Staff
 Physicians as citizens
 Should particularly co-operate with the authorities in the
administration of sanitary/public health laws and
regulations.
 Public and community health
 Should enlighten the public concerning quarantine
regulations and measures for the prevention of epidemic
and communicable diseases.
 Pharmacists/nurses
 Should promote and recognize their services and seek
their cooperation.

24. Unethical Acts
•Advertising
•Patent and Copy rights
•Running an open shop and Appliances by
• Rebates and Commission
•Secret Remedies
•Human Rights
•Euthanasia

25. Misconduct
 Violation of regulations
 Adultery or improper conduct
 Conviction in court of law
 Sex determination test
 Signing false professional
certificates, reports & other
documents
Any registered practitioner who is shown to have signed or given under his name
and authority any certificate, notification, report or document which is untrue,
misleading or improper, is liable to have his name deleted from the Register

27. Punishment & Disciplinary
Action
 Complaint is first heard by appropriate medical
council .
 During the enquiry the full opportunity is given to
registered medical practitioner to be heard in
person or by pleader.
 The decision has to be taken within 6 months.
 Appropriate medical council gives
decision according to the case.
 During the pendency of the complaint the
appropriate council may restrain the physician from
performing the procedure or practice which is
under scrutiny.

28. Punishment & Disciplinary
Action
 Complaints heard by Medical Council of
India (MCI) - as an apex body
 If appropriate medical council’s decision is not
acceptable, the petitioner or the RMP may
then appeal to MCI within 60 days from the
date
of receipt of the order.
 If no action is taken by appropriate
medical council within 6 months, then the
case may be directly appealed to MCI.

29. Punishment & Disciplinary
Action
 The punishment given by the appropriate medical
council or MCI includes:
 Warning
 Reprimand – official action
 Cancellation of registration
 Temporary – for specific period of time.
 Permanent

30. Public health ethics
Key issues in public health ethics
Disparities in health status, access to health care and to the
benefits of medical research
Responding to the threat of infectious diseases
International cooperation in health monitoring and
surveillance

31. Public health ethics
Key issues in public health ethics
Participation, transparency, and accountability
Exploitation of individuals in low-income countries
Health Promotion

32. Public Health Ethics
General Moral Considerations
 Providing Benefits.
 Avoiding, preventing, and removing harms.
 Producing maximal balance of benefits over
harms and other costs.
 Distributing benefits and burdens fairly (
Distributive Justice) and ensuring
public participation.

33. Public Health Ethics
 Respecting autonomous choices and actions,
including liberty of action.
 Protecting privacy and confidentiality.
 Keeping promises and commitments.
 Disclosing information as well as speaking
honestly and truthfully.
 Building and maintaining trust.

34. Ethical principles in public health
 Harm Principle
 Principle of least restrictive means
 Reciprocatory Principle
 Transparency Principle

35. Harm Principle
 “The only purpose for which power can be
rightfully exercised over any member of a
civilized community ,against his/her will, is to
prevent harm to others. His/her own good,
either physical or moral, is not a sufficient
warrant”

36. Least Restrictive Means
 A variety of means exist to achieve public health
ends.
 Education, facilitation and discussion should
precede coercive methods.
 More coercive methods should be employed only
when less coercive methods have failed.
 This principle has been enshrined in the Siracusa
principles, a set of internationally agreed upon
legal principles that establish the justified
conditions for the restriction of civil liberty.

37. Reciprocatory Principle
 Complying with public health requests may
impose burdens on individuals – need to
compensate.
 Society must be prepared to facilitate
individuals and communities in their efforts to
discharge their duties.

38. Transparency Principle
 Manner and the context in which decisions are
made.
 All legitimate stakeholders should be involved
in the decision making process, have equal
input into deliberations.
 Decision making manner- clear and
accountable.

39. Research ethics
•Principles in Ethical Research
 Social Value –
•The study should help researchers determine
how to improve people’s health or well-being.
 Scientific Validity –
•The research should be expected to
produce useful results and increase
knowledge .
Good research is reproducible
and has minimum bias.

40. Research ethics
 Fair Subject Selection
 Favorable risk-Benefit ratio-
Any risks must be balanced by the benefits to
subjects, and/or the important new knowledge
society will gain.
 Independent review –
A group of people who are not connected to
the research are required to give it an
independent review.

41. Research ethics
 Informed consent –
 Subject must be competent.
 The researcher must give a full disclosure.
 Subjects must understand what the researcher tells
them.
 The subject’s decision to participate must be
voluntary.
 Respect for enrolled Subject

42. ICMR guidelines -2006
 The statement of Ethical Guidelines for
Biomedical Research on Human Participants
shall be known as the ICMR Code and shall
consist of the following:-
 (a) Statement of
General
Principles
on Research using Human
Participants in
Biomedical Research
 (b) Statement of Specific Principles on
Research using Human Participants in specific
areas of Biomedical Research

43. Ethical Guidelines for
Biomedical Research
All institutions in the country which carry out
any form of biomedical research involving
human beings should follow these guidelines
in letter and spirit to protect safety and well
being of all individuals.
It is mandatory that all proposals on biomedical
research involving human subjects should be
cleared by an appropriately constituted
Institutional Ethics Committee (IEC)

44. General Principles
 Principles of essentiality
 Principles of voluntariness, informed consent
and community agreement
 Principles of non-exploitation
 Principles of privacy and confidentiality
 Principles of precaution and risk
minimisation
 Principles of professional competence

45. General Principles
 Principles of accountability and transparency
 Principles of the maximisation of the public
interest and of distributive justice
 Principles of institutional arrangements
 Principles of public domain
 Principles of totality of responsibility
 Principles of compliance

46. Specific Principles
 Clinical Trials of Drugs, Devices, Vaccines,
Diagnostic agents, Herbal Drugs
 Epidemiological Studies
 Human Genetics and Genomic Research
 Transplantation Research including Fetal
tissue and Xeno- transplantation
 Assisted Reproductive Technologies

47. Legally valid Consent
 given by person himself if above 12 years of age,
conscious and mentally sound (Sec. 88 IPC). Or,
 given by parent, guardian or friend if person is < 12 yrs.
or is unconscious or is insane (Sec. 89 IPC).
 is given freely, voluntarily and directly.
 is given without fear, force or fraud.
 is a written consent.
 non-written consent is formally documented &
witnessed by two witnesses.

48. Institutional Ethics Committee
Basic responsibilities-
• Ensure competent review of proposals.
• Ensure execution free of bias and influence.
• Provide advice to researchers.
Composition-
• 8-12 members – multidisciplinary
.
1.Chairperson
2.1-2 basic medical scientists.
3.1-2 clinicians from various Institutes
4.One legal expert or retired judge
5.One social scientist / representative of
non- governmental voluntary agency
6.One philosopher / ethicist / theologian
7.One lay person from the community
8.Member Secretary

49. Institutional Ethics Committee
 Review Process
• Through formal meetings
• Submission of application
• Prescribed format with study
protocol
• At least 3 weeks in advance
 Decision Making Process
 Interim Review
 Record Keeping
INSTITUTIONAL ETHICS COMMITTEE, PGIMS ROHTAK
• Chairman: Vice chancellor
• Pro Vice chancellor
• Director
• Dean PGIMS
• Sh. Ram Mehar (Retd. Engineer)
• Dr. Nirmal Gulati (Ex HOD- Gynae)
• Medical Supdt. PGIMS
• Head of Dept of Law, MDU Rohtak
• Dr. Pardeep Khanna (HOD Community Medicine)
• Dr. M.C. Gupta (HOD Pharmacology)
• Dr. Pradeep Garg (Sr. Professor Surgery)-Member
Secretary

50. Case study I
Commercial Surrogacy and Fertility tourism In India
– A case Study By Kenan Institute for Ethics, Duke
University,USA
A Japanese couple traveled to India in late 2007 to hire a
surrogate mother to bear a child for them. They
contacted Dr. Patel in Anand , Gujarat
The doctor arranged a surrogacy contract with
Pritiben Mehta, a married Indian woman with children
Dr. Patel supervised the creation of an embryo from
Japanese father’s sperm and an egg harvested from
an anonymous Indian woman.

51. The embryo was then implanted into Mehta’s womb.
In June 2008, the Japanese couple divorced, and a
month later Baby Manji was born to the surrogate
mother.
Although the Japanese father wanted to raise the
child, his ex-wife did not.
Baby Manji had three mothers—the intended mother
who had contracted for the surrogacy, the egg donor,
and the gestational surrogate—yet legally she had
none.

52. Case study II
Aruna Shanbaug case- Karnataka
In 1973, while working as a junior nurse at King Edward
Memorial Hospital, Mumbai, she was sexually assaulted
by a ward boy
She has been in a vegetative state since the assault
A plea for euthanasia was filed in the Supreme Court
by Pinki Virani , a writer and journalist.

53. Case study II
On 24 January 2011, after she had been in this status
for 37 years, the Supreme Court of India responded
to
the plea for euthanasia
The court turned down the mercy killing petition
on 7 March 2011
The debate on passive and active euthanasia
continues.

54. References
 Manual of Medical Ethics – World Medical
Association(2009)
 MCI ethical guidelines – 2002.
 ICMR guidelines for biomedical research,
2006.
 Research Ethics – National Institute of Health ,
USA.
 Issues in Public Health Ethics – ICMR
 The contribution of ethics to public health –
Bulletin of WHO